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Coronavirus: Your Questions About Coronavirus Testing, Answered

Coronavirus: Your Questions About Coronavirus Testing, Answered



America needs a national testing plan. In the absence of that, here’s what local governments, institutions and individuals need to know.

The editorial board is a group of opinion journalists whose views are informed by expertise, research, debate and certain longstanding values. It is separate from the newsroom.

Credit…Philip Cheung for The New York Times

Six months into the global coronavirus pandemic, Americans trying to navigate daily life remain trapped between a clear ideal — the country needs to test as many people as possible for the virus, as regularly as possible, for as long as possible — and the reality that there are nowhere near enough tests in the United States to do that.

Widespread testing is the key to opening schools and businesses safely. It’s the only way to get a handle on where the coronavirus is spreading, whether efforts to control it are working and what precautions are needed in any given community at any given moment. But funding shortfalls and bottlenecks mean that nearly every entity in the country is falling far short of that goal.

By most estimates, the United States is conducting fewer than five million tests per week on average, a far cry from the 30 million per week that experts were hoping to achieve by this fall. In some communities it remains difficult to find a test at all. In others, results take a week or longer to come back, making them all but useless.

These shortcomings have left institutions and individuals with a string of intractable questions: When should people without symptoms get tested? Who should be granted priority when supplies are limited? Which kinds of coronavirus tests should be used under which circumstances?

There does not seem to be any consensus on these questions. Some schools are requiring entry testing for returning faculty and students, even in places where tests are difficult to come by. Others are not, even where transmission rates are high. The N.B.A. is testing everyone; the meatpacking industry is not. And while the Trump administration is reportedly working to supply the nation’s nursing homes with rapid point-of-care tests — as is urgently needed — it has neglected to do the same for other congregant living facilities, like prisons, where outbreaks have devastated populations.

Much of this discord could have been prevented if America had developed a national testing strategy early in the pandemic — with local, state and federal officials coordinating to clear supply chain bottlenecks and public and private entities working together to develop rapid point-of-care tests.

There is no shortage of road maps for correcting course. The administration could dust off the national testing plan its own advisers created. Or it could look to the roster of organizations — including the Rockefeller Foundation — that have developed similar proposals. But even at this stage in the pandemic, with many thousands of lives and livelihoods lost, federal leaders are acting too slowly.

Amid this void in leadership — and the abundant confusion over testing across America at the moment — here’s what state and local leaders, parents, business owners and individuals should keep in mind.

What should the federal government be doing? A joint report from Duke University and the Johns Hopkins School of Public Health calls for a $75 billion investment in a national testing strategy. That’s a lot of money, but it’s a small price to pay for getting the U.S. coronavirus epidemic under control.

Even if federal leaders don’t invest that much, they at least ought to consider giving companies a stronger incentive to test people quickly. As Bill Gates and others have suggested, companies should be reimbursed by insurers, or paid by the federal government, based on how quickly they can deliver test results: Mr. Gates suggests paying extra for results that arrive in 24 hours, less for those that take 48 hours, and nothing for those that take longer (because by then, those results are useless).

What can state and local governments do in the meantime? As frustrating as it sounds, some testing companies have been reluctant to increase production of rapid point-of-care tests because they haven’t been assured that those additional tests will be purchased. State leaders can allay some of that hesitancy if they band together to make purchase guarantees with the companies — as some have already begun to do.

State and local leaders also should consider broader surveillance strategies for detecting coronavirus outbreaks, such as waste water testing. And they should make any data they have on case counts, positivity rates and so on as publicly available and usable as possible.

What about individual institutions? Until testing capacity is vastly expanded, it will be nearly impossible to devise a meaningful testing strategy for schools, offices and other institutions — not only because results need to come in quickly to be actionable, but also because any successful strategy will require repeated testing over many months.

One thing individual entities should consider given these shortages is a targeted surveillance strategy, where a proportion of asymptomatic people (students, staff members, residents) are systematically tested. That would require stocking up on rapid point-of-care tests (it’s likely you’d be getting what are known as antigen tests) and training people to administer them — hurdles, to be sure. But doing so would help officials detect potential outbreaks.

Should schools require testing? The Centers for Disease Control and Prevention recently advised that universities don’t need to consider entry testing — that is, testing staff and students before they’re allowed on campus. The C.D.C.’s argument is that such testing hasn’t been specifically studied for this coronavirus. “That’s akin to observing that seatbelts save lives in Cleveland but refusing to recommend them in Cincinnati because that’s a different city,” says Carl T. Bergstrom, a biology professor at the University of Washington. “It makes much more sense to say, ‘Entry testing is a best practice. We understand it’s not feasible in a lot of places, but we still think everyone should try.’”

Schools should be mindful of local testing availability when they set their testing requirements, and should consider implementing their own targeted surveillance programs when possible — perhaps deciding grade by grade, or classroom by classroom, to determine what level of reopening is safe. Schools in communities where the virus is spreading unchecked should not open.

Given the shortages and delays, when should people seek testing? Ideally, every person in America would get tested every few days — because we know that at least one-third of people who are infected and contagious have no symptoms.

But there is simply not enough capacity to do that many tests. Because results that take more than two days to arrive are effectively useless, it only makes sense to get tested in certain circumstances. If you think you were exposed to the coronavirus, and you can’t easily quarantine until the threat of contagion passes, you’ll want to get what’s known as a PCR test — that’s the most common type of test right now, available at most testing sites — to know whether you have an active infection and pose a risk to others. Ideally you would get tested twice — once soon after exposure, and again about a week later. (It often takes several days to develop an active infection.)

Getting tested when you have no symptoms or clear exposure is, at this point, of limited value because it can’t be done routinely. But it might make sense to get screened if you are planning to visit elderly or immunocompromised friends or loved ones. In this scenario, ideally you’d get two PCR tests, a week or so apart, and quarantine while you wait for your results.

Unfortunately, both of these scenarios assume you live in an area without long testing delays — which is a big assumption at the moment. Yes, this is extremely frustrating.

What’s the point of investing in testing if a vaccine is on its way? A vaccine will not necessarily eliminate the need for rigorous testing. Not only will it take time to deploy, but if a vaccine is less than 100 percent effective, testing will still be needed to monitor the spread of the virus in communities.

In other words, the coronavirus is not going away anytime soon. If leaders — at any level — want to keep schools open, restart the economy and eventually return to normal life, they’ll have to start resolving these issues.

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